Social Media in Neurosurgery: Are You HIPAA Compliant?

Kris.colenGuest post from
Chaim B. Colen, MD (left)
Chair of the Young Physicians Representative Section of the CSNS
Grosse Pointe Woods, MI
Kristopher T. Kimmell (right)
Neurosurgical Resident, University of Rochester Medical Center
Rochester, NY

The business of medicine is increasingly performed electronically. A wide variety of devices provide neurosurgeons with patient information right at their fingertips. Mobile technologies and social media offer tremendous potential to enhance neurosurgical practice and augment patients’ involvement in their care. However, there are two particular issues that neurosurgeons must give heed to when harnessing the power of mobile technologies and social media. The first is potential breaches of patient personal health information (PHI). The second is to maintain professional conduct in the use of social media for advocacy, marketing, and patient outreach.

Violations of the Health Insurance Portability and Accountability Act, or HIPAA, can come with substantial financial penalties. Fines from the Department of Health and Human Services for HIPAA breeches can easily reach six figures, irrespective of any civil liability. Neurosurgeons must be aware that they are responsible for their employees’ use of social media as well. An OB/GYN practice in Pennsylvania nearly ran afoul of HIPAA after an employee posted derogatory comments about patients on Facebook. Neurosurgeons should familiarize themselves with the keys aspects of HIPAA regulations as they relate to the use of electronic devices and social media. Detailed information can be found at the HHS HIPPA website by clicking here.

iphoneSocial media websites represent another avenue for PHI breaches in medicine. Physicians report high rates of use of social media websites (almost 90 percent by one report). Social media is being accessed by physicians not only for personal use but increasingly for professional networking. On platforms like Sermo or Doximity, physicians can engage in real-time case discussion with colleagues on challenging diagnoses or debate therapeutic options. Moreover, online patient communities have become tremendous forces for patient education and advocacy and can represent a great opportunity for providers to reach out to new patients and increase patient awareness and adherence. However, social media does present challenges for providers. The Federation of State Medical Boards (FSMB) recently published Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice for physicians. The FSMB Guidelines point out that physicians may be subject to disciplinary action by their medical board for inappropriate use of social media with the potential for license revocation in cases of flagrant violations. Similar to HIPAA breeches, neurosurgeons are monetarily liable for inappropriate social media use by themselves and their employees.

Most healthcare institutions have well-established policies and guidelines to prevent HIPAA violations. Some medical centers have also developed social media policies. Neurosurgeons should work closely with their own institutions to adopt appropriate practices and procedures. Ultimately neurosurgeons are responsible for their own use of mobile technologies and social media to carry out the practice of neurosurgery. Below are some things to consider in using mobile technologies and social media in your practice:

• Make sure that all devices (smartphones, tablets, laptops, etc) are password protected
• Take every precaution to protect patient’s privacy
• Provide candid disclosure of conflict of interest
• Avoid posting information that could be taken out of context
• Maintain an atmosphere of professionalism at all times

There is no question that social media and mobile technologies have dramatically impacted the way we communicate. And, even though these tools add valuable knowledge to a physician’s toolbox, it’s important for neurosurgeons to be mindful of the responsibility associated with them.

Posted in Guest Post, HCSM, Health, Healthcare Social Media | Tagged , , , , , |

Dartmouth Atlas Finds Significant Variations in Cerebral Aneurysm Care; Cites Importance of Neurosurgery’s Registry in Improving Patient Outcomes

Guest Post by Nicholas Bambakidis, MD
Professor of Neurosurgery and Director, Cerebrovascular and Skull Base Surgery
Residency Program Director, Neurological Surgery
University Hospitals Case Medical Center
Cleveland, OH

bambakidis_photoThe Dartmouth Institute recently published a review of cerebral aneurysm care as part of their “Atlas of Health Care” series. The report, “Variation in the Care of Surgical Conditions: Cerebral Aneurysms A Dartmouth Atlas of Health Care,” focuses on unwarranted variation of surgical care in the United States, which is not explained by patient needs or preferences. The review includes recent literature on outcomes in the treatment of both ruptured and unruptured cerebral aneurysms. The report found that the frequency of endovascular coiling of aneurysms has increased on average in recent years, but after the initial surge, the use of coiling has stabilized to between 60-70 percent of aneurysm treatment. Likewise, after an initial decline in aneurysm clipping, rates have stabilized, and clipping continues to be a mainstay of aneurysm treatment.

The aforementioned findings reflect the realization that emerging endovascular technologies are insufficient to adequately treat all aneurysms and lead to significant rates of recurrence and the need for retreatment in some cases. It also points out the importance of individualizing treatment based on patient-specific criteria. The study found significant variation regionally across the United States with respect to rates of clipping vs. coiling, which, unfortunately, may be related to other factors such as physician training, experience, and preference.

aneurysm image

Image of an aneurysm

In order to minimize such extraneous influences, it is important that high quality specialized care in all aneurysm treatment modalities be available at centers of excellence, such as Comprehensive Stroke Centers (CSC) that are certified by the Joint Commission. Unfortunately, the Cerebrovascular Coalition — which includes national physician specialty societies (including the AANS and CNS) whose members treat stroke patients — is concerned that the current CSC criteria are insufficient to guarantee appropriate expertise in all aneurysm treatment modalities. It is, therefore, imperative that the Joint Commission modify these standards to best meet the needs of patients.

The Dartmouth study also points out that the best outcome with respect to aneurysm treatment (either clipping or coiling) remains controversial and is still an important gap in knowledge. The study proposes further research into outcomes through the use of clinical data registries. Importantly, the authors highlighted the launch of the cerebrovascular module of the National Neurosurgery Quality and Outcomes Database (N2QOD) as an ideal effort in this regard. This reinforces the notion, in the absence of complete registry data, multimodality therapy must be available in order to best offer adequate treatment options to patients with cerebral aneurysms and to avoid unwarranted variation of aneurysm care which is not grounded in sound scientific rationale.

At the end of the day, patients who receive a new diagnosis of cerebral aneurysm (especially unruptured) face a difficult road to informed decision-making. Understanding their needs, addressing their concerns, and creating new quality paradigm, which promotes the use of clinical outcome registries, will be central to the process of minimizing variability and orchestrating a patient-centered approach to cerebral aneurysm treatment.

Posted in Access to Care, Guest Post, Health, Quality Improvement | Tagged , , , , , , , |

Faces of Neurosurgery: AMA Honors Neurosurgeons Karin Muraszko and Shelly Timmons

Ann.MayaGuest post from
Ann R. Stroink, MD, FAANS (left)
Central Illinois Neuro Health Sciences
Bloomington, Illinois
Maya A. Babu, MD (right)
Neurosurgical Resident, Mayo Clinic
Rochester, MN

September is the month that the American Medical Association (AMA) celebrates and honors influential women physician leaders in conjunction with their program entitled, “Women in Medicine.” As part of the AMA’s commitment to, “increasing the influence of women physicians and advocating for women’s healthcare issues,” the AMA identifies top leaders in medicine through a nomination process.

Reflective of this year’s theme, “Innovators and Leaders Changing Health Care,” Neurosurgery holds a distinct and unusual honor of celebrating two of our neurosurgeons, Drs. Karin Muraszko and Shelly Timmons, who have won the Inspirational Physician Award. This award acknowledges physicians who have, “offered their time, wisdom and support to advance women in medicine.”


Dr. Karin Muraszko (left) and Dr. Shelly Timmons (right)

Dr. Muraszko was nominated by Dr. Aruna Ganju, who had this to say about her, “Karin is currently the first and only female chairperson in neurosurgery in the United States. She has devoted herself to the neurosurgical field providing outstanding service to her pediatric patients and their families, providing national leadership and serving as a role model to women in neurosurgery. As the mother of two adopted children, she inspires us by finding work/life balance and providing service to the community. Dr. Muraszko should be recognized as a truly inspirational woman.”

Dr. Timmons was nominated by Dr. Karin Muraszko, who said, “Shelly maintains an optimistic disposition even when dealing with the most difficult and complex political circumstances. I believe she is an inspirational physician because of her overall ability to help inspire a generation of young physicians in how to take care of patients, provide them with cutting edge therapy, and most importantly treating individuals with respect and dignity.”

Our behalf of Neurosurgery’s entire AMA delegation, we ask our fellow neurosurgeons to congratulate these two honorees and celebrate this recognition on the national stage of organized medicine.

Posted in Faces of Neurosurgery, Guest Post, Health | Tagged , , , , |